Inoue T, Sohma R, Miyazaki T, Iwasaki Y, Yaguchi I, Morooka S
Department of Cardiology, Koshigaya Hospital and Institute for Medical Science, Dokkyo University School of Medicine, Koshigaya City, Saitama, Japan.
Am J Cardiol. 2000 Nov 15;86(10):1057-62. doi: 10.1016/s0002-9149(00)01159-0.
The pathophysiologic features of stent-induced cellular responses of platelets and leukocytes have not been established. This study was designed to clinically investigate the activation of platelets and neutrophils after coronary stenting and to identify its effects on the long-term results of coronary stents. Forty-eight consecutive patients with left anterior descending coronary artery disease indicating coronary intervention were randomly assigned to either a balloon angioplasty group or a coronary stent group. Flow cytometric analysis demonstrated that the transcardiac gradient (the value of coronary sinus blood minus the value of peripheral blood) of platelet surface expression of CD62P (p < 0.001) and CD63 (p < 0.01) increased immediately after coronary stenting, but increased less significantly immediately after balloon angioplasty (CD62P, p < 0.01; CD63, p < 0.05). These increases were persistently observed after coronary stenting but transiently after balloon angioplasty alone during a 48-hour observation period after the procedures. The gradient for neutrophil surface expression of CD11b increased, and that of CD62 L decreased 48 hours after coronary stenting (CD11b, p < 0.001; CD62 L, p < 0.05), but these changes showed less significance 48 hours after balloon angioplasty alone (CD11b, p < 0.05; CD62 L, p = NS). The gradients 48 hours after the procedures for both CD62P (r = 0.39, p < 0.05) and CD11b (r = 0.44, p < 0.01) were independently correlated with the late loss in the stent group, whereas the correlation was seen only for CD11b (r = 0.38, p < 0.05) in the balloon angioplasty group. Both platelet and neutrophil activation was greater after coronary stenting than after balloon angioplasty. Cellular interactions between platelets and neutrophils may be related to the progression of neointimal proliferation leading to restenosis after coronary stent implantation.
支架诱导的血小板和白细胞细胞反应的病理生理特征尚未明确。本研究旨在临床调查冠状动脉支架置入术后血小板和中性粒细胞的激活情况，并确定其对冠状动脉支架长期效果的影响。48例连续的左前降支冠状动脉疾病且需冠状动脉介入治疗的患者被随机分为球囊血管成形术组或冠状动脉支架组。流式细胞术分析表明，冠状动脉支架置入术后，血小板表面CD62P（p<0.001）和CD63（p<0.01）表达的跨心脏梯度（冠状窦血值减去外周血值）立即升高，但球囊血管成形术后立即升高的幅度较小（CD62P，p<0.01；CD63，p<0.05）。在术后48小时的观察期内，冠状动脉支架置入术后这些升高持续存在，而单独球囊血管成形术后则短暂存在。冠状动脉支架置入术后48小时，中性粒细胞表面CD11b表达梯度升高，CD62L表达梯度降低（CD11b，p<0.001；CD62L，p<0.05），但单独球囊血管成形术后48小时这些变化的显著性较低（CD11b，p<0.05；CD62L，p=无显著性差异）。术后48小时CD62P（r=0.39，p<0.05）和CD11b（r=0.44，p<0.01）的梯度在支架组均与晚期管腔丢失独立相关，而在球囊血管成形术组仅CD11b（r=0.38，p<0.05）有相关性。冠状动脉支架置入术后血小板和中性粒细胞的激活均比球囊血管成形术后更明显。血小板与中性粒细胞之间的细胞相互作用可能与冠状动脉支架植入术后导致再狭窄的新生内膜增殖进展有关。
